TAVI gives better hope for those ailing with valvular heart disease
Medical technology has progressed by leaps and bounds over the past few years. In terms of cardiology, the Percutaneous Transcatheter aortic valve implantation (TAVI) has opened up the possibility for treating patients who until now had been left untreated because it was believed that their operative mortality outweighed the benefits offered by traditional aortic valve replacement (AVR).
Novel transcatheter therapies for valvular heart disease have developed tremendously over the past decade. These innovative interventional methods are largely modeled from established surgical heart valve procedures, which have started to evolve to less-invasive approaches. Until a decade ago, interventional valve procedures included only balloon pulmonary, aortic, or mitral valvuloplasty, serving highly selected patients. In 2002, percutaneous valve therapy advanced greatly with the first catheter-based aortic valve replacement (AVR) procedure. Since then more than 55000 high-risk patients have had percutaneous aortic valve replacement worldwide.
Speaking about the procedure Dr. Uday Khanolkar, Senior Consultant Cardiologist, Narayana Health City says: “Percutaneous heart valves are stent – based xenografts that are collapsed onto a catheter and are expanded at the time of implantation. Procedure is performed in a catheterization laboratory, usually by placing a sheath in the femoral artery. The prosthetic stent valve is mechanically crimped onto a balloon catheter immediately before implantation. With a steerable guiding catheter, the balloon-mounted valve is passed retrograde through the aorta and positioned within the native aortic annulus. Positioning is confirmed by fluoroscopy, aortography, and transesophageal echocardiographic imaging. The delivery balloon is then inflated to expand the valved stent, thereby excluding and compressing the native aortic valve.”
The transapical approach is the most recently developed form of transcatheter AVR. The procedure involves a small left lateral thoracotomy and is performed in a hybrid operative suite. It requires a direct puncture and sheath insertion into the left ventricle. Patients who require AVR but have a “porcelain aorta” or have peripheral vascular disease should be considered for the transapical approach. “None of the procedure requires cardiopulmonary bypass or a sternotomy, and the femoral approach may not require general anesthesia. Because they are delivered via a catheter, percutaneous heart valves have the potential advantage of lower perioperative morbidity; mortality and lesser hospital stay (3-4 days) than valves implanted using conventional surgical approaches. The procedure is reserved for those people for whom an open heart procedure is too risky. For that reason, most people who have this procedure are in their 70s or 80 and often have other medical conditions that make them a better candidate for this type of surgery” he further added.